Function and Frailty: Value Added in Medicare
Authors: Julie P.W. Bynum
Journal: Annals of Internal Medicine (2023)

EditorialsApril 2023Function and Frailty: Value Added in MedicareJulie P.W. Bynum, MD, MPHJulie P.W. Bynum, MD, MPHDepartment of Internal Medicine, University of Michigan Medical School, Ann Arbor, MichiganAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-0563 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail With Medicare's nearly $690 billion dollars of spending in 2021 (1), getting payment right is a high-stakes business. Risk adjustment, the process of assigning a score to the health status of individuals to predict health care costs, is a central component used to determine payment in value-based models of care and Medicare Advantage. The same measures are also used by health systems to segment their population into distinct groups based on the type of care they need. Typically, morbidity, measured by number and types of diseases, is used for risk measures. Because most chronic diseases are age related, older adults, ...References1. Cubanski J, Neuman T. What to know about Medicare spending and financing. Kaiser Family Foundation. 19 January 2023. Accessed at www.kff.org/medicare/issue-brief/what-to-know-about-medicare-spending-and-financing on 28 February 2023. Google Scholar2. Johnston KJ, Wen H, Joynt Maddox KE. Relationship of a claims-based frailty index to annualized Medicare costs: a cohort study. Ann Intern Med. 2020;172:533-40. [PMID: 32252070] doi:10.7326/M19-3261 LinkGoogle Scholar3. Kim DH, Patorno E, Pawar A, et al. Measuring frailty in administrative claims data: comparative performance of four claims-based frailty measures in the U.S. Medicare data. J Gerontol A Biol Sci Med Sci. 2020;75:1120-5. [PMID: 31566201] doi:10.1093/gerona/glz224 CrossrefMedlineGoogle Scholar4. Ensrud KE, Schousboe JT, Kats AM, et al. Incremental health care costs of self-reported functional impairments and phenotypic frailty in community-dwelling older adults: a prospective cohort study. Ann Intern Med. 2023;176:463-471. doi:10.7326/M22-2626 LinkGoogle Scholar5. Joynt KE, Figueroa JF, Beaulieu N, et al. Segmenting high-cost Medicare patients into potentially actionable cohorts. Healthc (Amst). 2017;5:62-7. [PMID: 27914968] doi:10.1016/j.hjdsi.2016.11.002 CrossrefMedlineGoogle Scholar6. Varga TV, Niss K, Estampador AC, et al. Association is not prediction: a landscape of confused reporting in diabetes - a systematic review. Diabetes Res Clin Pract. 2020;170:108497. [PMID: 33068662] doi:10.1016/j.diabres.2020.108497 CrossrefMedlineGoogle Scholar7. Calderón-Larrañaga A, Vetrano DL, Ferrucci L, et al. Multimorbidity and functional impairment–bidirectional interplay, synergistic effects and common pathways. J Intern Med. 2019;285:255-71. [PMID: 30357990] doi:10.1111/joim.12843 CrossrefMedlineGoogle Scholar8. Bynum JPW, Austin A, Carmichael D, et al. High-cost dual eligibles' service use demonstrates the need for supportive and palliative models of care. Health Aff (Millwood). 2017;36:1309-17. [PMID: 28679819] doi:10.1377/hlthaff.2017.0157 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Julie P.W. Bynum, MD, MPHAffiliations: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MichiganDisclosures: The author has reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-0563.Corresponding Author: Julie P.W. Bynum, MD, MPH, Department of Internal Medicine, University of Michigan Medical School, 2800 Plymouth Road, NCRC, Building 16, Ann Arbor, MI 48109; e-mail, bynumju@med.umich.edu.This article was published at Annals.org on 4 April 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIncremental Health Care Costs of Self-Reported Functional Impairments and Phenotypic Frailty in Community-Dwelling Older Adults Kristine E. Ensrud , John T. Schousboe , Allyson M. Kats , Brent C. Taylor , Cynthia M. Boyd , and Lisa Langsetmo Metrics April 2023Volume 176, Issue 4Page: 578-579KeywordsElderlyFrailtyMedicareValue based health care ePublished: 4 April 2023 Issue Published: April 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...